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H l~qC Kr ~Jw,IL,r~ irL bb31" ii~d Avtr {~, N~w yolk %4 y !~3DI7 [ !{~' 5,UG DECA Memorandum November 27, 1979 Environmental Health Memorandum GROWING ATTENTION TO DIET-CANCER LINK SPURS NEW LOOK AT NUTRITION POLICY The connection between diet and health in the united States is under scrutiny as never before both by goverD]nent and private groups -- with deep implications for many segments of industry. Growing efforts to link the way we live and eat with cancer and other illnesses could lead to stronger regulatory pressures on the food and allied industries and perhaps to a lessening of public concern about some industries (notably the chemical in- dustry) that have been charged with responsibility for a sig- nificant amount of cancer. Ever since the National Cancer Institute (NCI) announced last year its intention to push research on the diet-cancer ]ink, there has been growing attention to the development of national health and nutrition policies. Additionally, there has been a spillover of concern about the way food products are sold and how children are taught to eat. This memorandum will look at some of the signlricant developments during the year, ~ncluding the sessions at the recent annual meeting of the Anlerican Public Health ASSociation (APHA) . Positive Health Strategy Recommended A recent article in the J~urr~al of the American Medical Association by Dr. Lester Hreslow of the Center for Health Science, University of California School of Public Health,* reflects one important t~end in th~ issue. ~e calls f~r a "positive strategy for the nation's health." The declzne in age-adjusted death rates and infant mortality, the control of conmlunicable diseases, and sub~ stantial advances against chronic diseases such as coronary heart disease and stroke, he said, p~ovide a new momentum toward ilu- proved heaZth. Breslow believes a negative health strategy which regards modern health problems as "inevitable consequences of aging't and often invests in measures that prolong deaLh instead of life has pre- vail~d in the past. Instead, he reco~ends development of a positive strategy aimed at promotin~ health, preventing disease ~-& and extending life through developing healthful lifestyles, assuring a healthful environment, and turning medicine toward health maintenance.

--2-- The strategy he suggests requires three main thrusts: ~i~r~- moting personal~habits favorable to health; (2) oountering enviro~- mental hazards, and (3) reorienting medicine to emphssi~e di~ase prevention and health maintenance. Healthfu[~naSI~s~include Control'of such factors'as'animal fat, alcohol, ~igaEettes and physical inactivity, Breslow suggested. To detect man-made diseases which result in part from harmful agents i~ the air, food and the ~orkplace, Breslow said. "we must establish systematic surveillance systems over environmental health hazards and adopt sensible, effective controls," According ta Breslow, preventive medicine deals with two factors. One examines bodily precursors of disease, such as high blood pressure, elevated cholesterol levels and susceptibility to in- fectious diseases. The second considers personal habits such as cigarette smoking, excessive alcohol use and eati~q too much. Public understanding of these risk factors is growing. Breslow says. ~eople~are more~aware of-~the dangers of~smoklng; self- care groups promoting increased awareness and personal responsibility for health are gaining popularity. A 1977 Lou Harris survey of large companies headquartered i~ Chicago showed two-fifths pro- viding preventive health programs for employees and another one- fifth of the companies considerinq such programs. Prevention Guidelines Issued by Government A~encles Last month the National Cancer Institute presented Senator George McGovern's Nutrition Subcommittee five "interim principles" for reducing cancer risk through changes in eating and drinking habits. Although presented in a cautiously worded statement by NCI Director Arthur C. Upton,* the recommendations are likely to stir controversy a~d further review. Health and nutrition experts differ in their views on the link between cancer and nutrition and there has been much criticism of the lack of adequate nutrition and cancer research. The NCI preventive guidelines recon~nend: -- Excessive body weight be avoided by balancing caloric intake with proper exercise. -- High intake of fat ought to be avoided, partly to control body weight, but also because of a suggestive association of fat consumption with the risk of cancer. -- A "generous" amount of fiber in the diet "seems prudente" based on a reduction i~ the incidence of bowel cancer i~ humans and animals consuming high amounts of fiber. -- Alcoholic beverages "should be consumed only An moderation," based on the correlation between drinking and the risk for certain cancers.

-3- Tentative U.S. Department of Agriculture diet guidelines are similar to NCI'S, but they add a recon%mendation that infants be breast fed and are not limited to connections with cancer. USDA guidelines also will include an economic impact analysis in final form. In addition, the Surgeon General a~nounced a similar set of principles as part of a health-related document issued last su~er. Meanwhile, the Department of Health and Welfar~ is now cir- culating for comment a draft report of "objectives~for the Nation,~ developed at a June HEW-sponsored conference in Atlanta. Con- sidering priorities set by the "Surgeon General's Report on Prevention," the report presents objectives for the 1980s which may help reduce premature death, diseases and disabling conditions. A Departmental review of comment~ will deter;nine which objectives become government policy. Secretary Patricia Harris will make the final decision. Ob~ec~ive~ed for 1990 ~clude -- Reduce infant mortality rates and attain immunization levels of at least 50 percent; -- ~onsumers and workers should have easy access to a central information source describing every substance or product known to be toxic to which they may be exposed"; -- "Sufficient penalties should be attached to toxic agents pollution to provide strong economic incentives to abate"; -- "Workers will be routinely informed of occupational health and safety risks prior ta employment, as well as any cha~es in those risks while employed"; -- "Reduce by 1 percent per year the mean body weight of adults, without nutritional impairment"; -- "Per capita consumption of alcohol should not exceed current levels"; -- Label~cigarette packages and ads with improved health warn, ings~and establish laws=in all 50 states to encourage non- smoking in public place~ and in work and dining areas~ Cancer Survey Studies Lifestyle Factors A ~ecently cQmpleted 20-year cancer survey of over one million~ Americans by the American Cancer Society* examined such factors as:smoking, sleep, exercise, air pollution, diet and the use of various drugs. Once again, prevention is highlighted. The study~Indicates smoklng~ alcohol~and'~tranquilizer use increase the risk of mortality, while~ obesity~(more~han 40 percent overweight) ~ncreases the rlsk of~ ~J

-4- certain types of cancer in both men and women. Men and women who sleep seven hours per night had lower death rates from heart attacks and strokes than those who sleep either more or less than seven hours. Interestingly, air pollution "was not found to be a great culprit in causing lung cancer. General air pollution had little effect in comparison ~ith urban and rural people," the study reported. One finding that should continue to fuel controversy over nutritional pollcy is the preliminary indication that people who ate a high-fat diet did not have a higher rate of coronary heart disease and stroke than those who ate a low-fat diet. However, because food items must be considered in combination rather than singly, and other variables must be included, the study warned against putting too much emphasis on such an in- dication at this time. Nutritionists View Prevention A special session of the American Public Health Association annual meeting, November 4-8, in New York, focused on "Child Nutrition and Family Health: Public Health Issues, Policy and Roles." Johanna ~'DWyer, Director of the Francis Stern Nutrition Clinic,* said fat levels and blood pressure levels in many U.S. children are much too high because of the diet our culture has adopted. To prevent adverse health effects from these early developing trends, she said, nutritionists must work in the coming decade to increase awareness of diet-health relationships, decrease problems of obesity, achieve mean blood cholesterol levels of 150 mg/l, cooperate with industry to remove some sugar and food additives from certain products and develop more informative labels. Discussing the effects of advertising on dietary habits at the same APHA session, Louise Light, U.S. Department of Agriculture,* suggested that we cannot afford to think of advertising as any- thing but a tool of preventive medicine and should encourage advertising that promotes good nutritional health for children and adults. Joan Gussow, Chairperson of the Nutrition Program at Columbia University,* said that our American children probably have to~ be taught to eat correctly from an early age. Every society, ~.& either inadvertently or deliberately, teaches food habits. If you surround children with a culture that eats properly, they will eat properly, Gussow said. In the past, she noted, the ~} most effective nutrition education has r~sulted. . from. addin~ ~-~ foods to the diet. For the first time in nutrltlonal history, ~& nutritionists are faced with teaching people to eat less of the foods that can affect various health factors.

-5- The consensus view suggested a need to change the environment around which our dietary habits are formed and change the quality of the foods encountered. Future Prospects ~oth:government'~nd private groups are at the beginnings of'a massive~effort to change basic lifestyle patterns of the American public-,~.a formidable task, Out of this effort will flow re- search reports, government actions, and public attention to the many conflicting views that are bound to emerge. The inevitable result will be controversy and as the debate continues, industry will face a necessity to deal with the various policy objectives that directly affect operations and customers and prepare to meet the new challenges these policy changes may cause• ~%rtlcles marked with an asterisk are available upon request from Ms;~Nona Masfello,~Division of Envirorunental and<Consume[ Affa~{s, Hill~and Knowlton, ~Inc, ~: 633 Third Avenue, New York" ~NY 1Q0"174 #### l'0